Kidney Cancer

What is Kidney Cancer?

Kidney cancer is among the 10 most common cancers that occur in the U.S. About 63,000 women and men are diagnosed with the disease each year. Your risk of developing kidney cancer increases as you get older. The average age at diagnosis is 64.

Your Kidneys

Most people are born with two kidneys. If you picture a kidney bean as large as your fist, you will have a good idea of what each kidney looks like. Your kidneys are located above your waist. One is on the right side of your spine, the other is on the left.

The kidneys take water, salt and waste out of your blood and turn them into urine. They also produce hormones that help control your blood pressure and that tell your bone marrow when to make more red blood cells. Your body will work fine with just one healthy kidney. That’s why a healthy person can choose to donate a kidney to someone whose kidneys are no longer working properly.

Risk Factors, Signs & Symptoms

There are a number of known risk factors for kidney cancer.

The highest risk is seen in women and men who have inherited a disease that increases the risk of kidney cancer or who have parents or siblings who have had kidney cancer. These diseases include:

Diagnosing Kidney Cancer

Some people learn they have kidney cancer after seeing a doctor because they have had health concerns such as:

blood in urine

pain or pressure in the side or back

swelling in the ankles and legs

high blood pressure

a low red blood cell count (anemia)

a high red blood cell count (erythrocytosis)

feeling very tired

loss of appetite

unexplained weight loss

recurring fever

a rapid enlargement in the veins around a testicle

If you have these symptoms, it does not mean you have kidney cancer. They are more commonly seen in people who have other health problems. But, your doctor may recommend additional tests.

Testing for Kidney Cancer

If you have health concerns that could be a sign of kidney cancer, your doctor will ask you to have some tests done. These could include:

urine tests

blood tests

imaging tests to get pictures of your kidneys

After these tests results come back, you may need to have a biopsy to remove a small piece of your kidney tumor to check for cancer cells. If you have cancer, you will likely need to have surgery to remove the tumor along with part or all of that kidney.

Types of Kidney Cancer

There are different types of kidney cancer. The most common type is renal cell carcinoma (RCC) which is seen in nine out of 10 people with kidney cancer. RCC is divided into different subtypes. These include:

Clear cell: This is the most common type. It is seen in three out of four people with RCC. These tumors have cancer cells that are very light, or clear, in color when examined under a microscope.

Papillary RCC: In these cancers, the cells form shapes that look like fingers.

Less Common subtypes:

chromophobe RCC

collecting duct carcinoma

medullary carcinoma

mucinous tubular and spindle cell carcinoma

multilocular cystic RCC

neuroblastoma-associated RCC

translocation RCC

unclassified RCC

Other Types of Kidney Cancer

Treatments for these types of kidney cancers are different than those for other types of kidney cancer.

Urothelial carcinoma or transitional cell carcinoma: Although this cancer can be found in the renal pelvis (where your kidney connects to your ureters), it similar to and is treated like bladder cancer. You can learn how bladder cancer is treated in this section of our website.

Renal sarcoma: These cancers begin in the blood vessels or connective tissue of the kidney. They are very rare.

Wilms tumor: This is the most common type of kidney cancer that occurs in children.

Choosing Your Health Care Team

Kidney cancer is usually treated by a team of experts. Your team can include:

your primary care provider

a urologist, who treats health problems that develop in the urinary tract and male reproductive organs

a urological oncologist, a urologist with additional training in treating cancer

a medical oncologist, with special training in the use of chemotherapy, targeted therapy and immunotherapy

an interventional radiologist, who uses imaging to biopsy a tumor or radiation to kill cancer cells

a nephrologist, who manages patients with poor kidney function, including those on dialysis

Second Opinions

It is widely recommended that people diagnosed with kidney cancer get a second opinion from another urologist, urological oncologist or medical oncologist about their diagnosis and treatment.

Getting a second opinion doesn’t mean you don’t trust your doctor. It means you want to be certain you know all of your options.

Kidney Cancer Staging

Treatment options for kidney cancer are based largely on your cancer’s stage. There are four stages:

Stage I (1): The tumor is no more than 7 centimeters (or 2 ¾ inches) in diameter, is inside the kidney and has not spread to the lymph nodes

Stage II (2): The tumor is 7 centimeters or larger and inside the kidney

Stage III (3): The tumor has spread outside of the kidney to surrounding tissue or veins, or is inside the kidney but has spread to nearby lymph nodes

Stage IV (4): The tumor has spread—or metastasized—from the kidney to nearby organs or to other parts of the body, such as the bones, liver or lungs

Types of Treatment

There are a number of treatments available for kidney cancer depending on your age, the size and stage of your cancer, and your overall health which will determine your treatment options. There are two types of treatment: localized and systemic treatments. Surgery and radiation are localized treatments. They remove or kill the cancer cells in or near the kidney. Systemic treatments involve immunotherapy and targeted therapy.

Active Surveillance or Observation

If you:

are older

have a very small cancer

have a serious medical condition like heart disease

your doctor may suggest watching the cancer instead of performing an invasive procedure to treat it. This is called active surveillance or observation.

Localized Treatment

There are two types of cancer treatments: localized and systemic. Surgery and radiation are localized treatments. They remove or kill the cancer cells in or near the kidney.

Surgery

To remove the tumor, your surgeon will need to remove some or all of your kidney. The procedure will be either a:

Partial nephrectomy (kidney-sparing or nephron-sparing surgery)

Often used for stage I (1), II (2), or III (3) kidney cancer.

The tumor and part of the kidney are removed.

OR

Nephrectomy (radical nephrectomy)

Used for a large tumor.

The whole kidney is removed.

Nearby lymph nodes and fatty tissue around the kidney may also be removed.

The adrenal gland, which sits on top of the kidney, may also be removed.

It will be done as an:

Open surgery

The traditional type of surgery done with a scalpel.

Recommended if the tumor is 4 inches (10cm) across or larger.

OR

Minimally-invasive Surgery

The surgeon uses special tools that are about ½ inch in diameter and a small camera.

The tools are inserted through small cuts in the abdomen.

When done with a laparoscope, it is called laparoscopic surgery.

May be done with the surgeon controlling robotic arms.

May be an option if the tumor is smaller than 4 inches.

For any surgery, surgeon skill and expertise is critical. Ask your surgeon how many surgeries of the type they have done or how many they do in a given month or year.

Radiation and Other Local Treatment Options

If you have other severe health problems, you may not be healthy enough to have surgery. In this case, your health care team may recommend:

Cryoablationorcryotherapy- This procedure uses very cold gas to freeze and kill the tumor cells. It is usually performed by an interventional radiologist or urologist.

Radiofrequency ablation- During this procedure the doctor puts a probe that uses heat to kill cancer cells directly into the tumor.

Arterial Embolization- Your doctor will insert a special material into the artery to keep the tumor from getting the blood it needs to grow. This procedure is also sometimes used to shrink the tumor before surgery or to reduce pain when the tumor can’t be removed.

Radiation therapy- This may be used to treat the primary tumor if surgery is not an option. Typically, radiation is only used to relieve pain or bleeding that might develop when the cancer spreads to other parts of the body.

Systemic Treatment: Stage III (3)

Traditional chemotherapy is not used to treat kidney cancer. These cancers respond better to other types of anti-cancer drugs, like targeted therapies and immunotherapies.

Targeted therapy or immunotherapy is sometimes used before surgery to shrink a large tumor. It may also be used after surgery in patients who are at a high risk for recurrence. You can learn more about targeted therapy and immunotherapy in the next section below titled Systemic Treatment: Stage IV (4) or Metastatic Kidney Cancer. A risk assessment tool can help you and your doctor assess how likely you are to have a recurrence within five years of surgery and the benefits and risks of additional treatment.

Your treatment options may also include clinical trials.

There are currently about 200 clinical trials taking place in the U.S. that are enrolling kidney cancer patients. You can:

Systemic Treatment: Stage IV (4) or Metastatic Kidney Cancer

If you have stage IV (4) kidney cancer, it means your cancer has spread, or metastasized, to other parts of your body. Some people (about 16 out of 100) will have an initial diagnosis of stage IV kidney cancer. In other cases, the cancer recurs, or comes back, as metastatic after initial treatment.

If you have not previously had surgery, your doctor may recommend that you have the kidney removed along with any tumors (metastases) that are near the kidney. Your doctor is also likely to recommend a systemic treatment. This could be a targeted therapy or an immunotherapy, or both.

Targeted Therapy

Different types of targeted therapies are used to treat kidney cancer. Some work by blocking the growth of the new blood vessels tumors need to survive. Others target specific proteins that help tumors grow. Some are pills you take by mouth. Others are infusions that go into your vein (IV). The most common side effects of targeted therapies are:

Looking Forward

As you go through treatment, you are likely to have many questions and concerns. You will have different types of questions and concerns after you have completed treatment, if your cancer recurs (comes back), or you have stage IV(4) or metastatic kidney cancer.

The more information you have about your diagnosis and treatments, the easier it will be for any health care providers you see to answer your questions.

A Survivorship Care Plan is a document that includes information about the treatments you have had and the follow-up care you need. Your doctor may provide you with one. Or, you may have to ask a member of your health care team to help you complete one.